The Hidden Cause of Back Pain

By Mitchell Yass, DPT

Very few of us get through life without every suffering some kind of back pain. Amanda’s case was in some ways typical. Never having had back problems, she one day lifted her toddler and was struck with crippling pain. It took weeks of self-care, chiropractic visits and therapy to restore normal movement.

Joey’s situation was more severe. Overweight and sedentary, with an apparent genetic predisposition, he was diagnosed with a herniated disc. His first surgery alleviated the problem for a number of years, but the second, third and fourth, along with a new diagnosis of stenosis, had only varying degrees of success. Despite many sessions of physical therapy, he will most likely have back issues for his entire life.

When we suffer from back pain we seek health care and perhaps, if it’s severe enough, medical attention. The typical process with severe back pain is to get an MRI, which certainly the medical community would agree is the standard of care. A herniated disc, pinched nerve or stenosis is identified and becomes the diagnosis for all subsequent treatments.

The problem with this premise is that in most cases the cause of back pain is muscular, and these types of findings are independent to the cause of the pain. In fact, the American College of Physicians in 2007 recommended that MRIs no longer be used to identify the cause of lower back pain because in 85 percent of cases the lower back pain could not be attributed to a spinal abnormality or a disease (they determined only 3 percent of cases could be attributed to herniated discs and 4 percent to stenosis). Just imagine that a muscle spasm, a muscle referring pain to another location, or a muscle straining and impinging on a nerve that refers pain to another location does not show up on an MRI.

How can you determine if the cause of your lower back pain is muscular? One simple step is to feel for the tissue emitting the pain. If your pain is across the lower back, try to press across the lower back away from the spine. If the pain you are experiencing is intensified by pressing on the tissue, this indicates that the pain is “point tender.” This means that the tissue you are pressing on is the tissue emitting the pain signal. In this case, you are most likely pressing on the lower back muscles called the quadrates lumborum (qls). If the pain were from a spinal abnormality, such as a herniated disc or stenosis, then you would have to press on the spine where the abnormality is to create the pain across the lower back. This is known as “referred pain.”

If the pain is point tender and associated with the lower back muscles, then the next question to ask is, why did the lower back muscles strain enough to emit pain? The answer in the majority of cases is that the lower back is being forced into an excessive arched position due to an imbalance between the front thigh muscles and back thigh muscles.

Here’s how it works: The quads (front thigh muscles) can become much stronger then the hamstrings (posterior thigh muscles) due to the extensive use of the quads in walking, climbing stairs, sitting and standing. If the imbalance between the muscles develops enough, the quads will shorten. Since the quads attach to the front of the pelvis, the shortening pulls the front of the pelvis down causing the back of the pelvis to rise, thus creating an excessive arching in the lower back. This altered posture causes the lower back muscles to shorten, making it more difficult for them to perform their task of supporting the torso. This can lead to these muscles straining and emitting pain at the lower back region.

Most health care practitioners believe that the answer to back pain is to strengthen your back and abdominal muscles, but that doesn’t address the source of the problem. The remedy is to stretch the quads and strengthen the hamstrings and buttock muscles, and other than yoga, which is the only form of remedial exercise regularly recommended for pain ranging from a herniated disc to ankylosing spondylitis (arthritis of the spine), the world needs new options.

Mitchell Yass, DPT, documents his breakthrough method of diagnosing the cause of pain and its treatment in The Pain Cure Rx: The Yass Method for Diagnosing and Treating Chronic Pain (Hay House, release date 6/2/15)